General Approaches to Health Research: Evolving conceptions of mind  body

1. Stressor, pathogen Internal Process Health Outcome General Approaches to Health Research: Evolving conceptions of mind  body Core construct: • General process: mediating models • What explains or accounts for a stress  outcome effect • Basic theory development & testing • Individual differences: moderating models • Establish “boundary conditions” of effect or theory • Specify sub-population characteristics of an effect • Descriptive or theory-based: important to specify in advance for efficacy trials.

2. Other health behaviors: Diet, smoking… Mediating (and additive) models Environ-mental change, Adaptation syndrome Arousal, inflammation CHD • Ψ; distress, helplessness • Physiological: • Corticosteroids, pro-inflammatory cytokines, HPA activation • Lipids, insulin section & “metabolic syndrome” • Developmental changes • SES, culture, etc. • Infectious process • Individual stress

3. Health behavior: diet, exercise, smoking… Mediating (and additive) models Environ-mental change, Adaptation syndrome Psych. Process Arousal, inflammation CHD Self-efficacy Helplessness / depression Social resources

4. Negative health behavior Exposure to pathogens Arousal (coritco-steroids) • Basic mediating models in health behavior Immune function Stress Illness

5. Immune function Negative health behavior Stress Illness Socio-economic status Exposure to pathogens Structural & cultural barriers to health care • Health models with structural exogenous variables

6. Immune function Stress Interaction of stimulus by Ψ resources Health status “Optimism”, “hardiness”, social support Health behavior Basic moderating model

7. Direct effects of Ψ on health • Psychoimmunology; Adar’s work on affect, learning and immune function • Classical conditioning models: • immune status, tolerance, withdrawal, placebo effects • Etiology: arousal or affective effects on health • stress responses, arousal, and cardio-vascular health • bereavement and health: see House on social ties and mortality • affect (depression), self-concept, optimism, “sense of coherence” and immune function • Specific stressors and obesity Key issue: articulation of complex relations among CNS, ANS, Immune, and other systems.

8. Indirect effects of Ψ on health • “Health behaviors”: risks, protective behaviors [primary prevention] • Individual social / cognitive models of ... • Self-regulation (self-awareness, self-monitoring, self-efficacy) • Health information processing • Self-perception and decision making: • optimism (realistic or unrealistic) • readiness to (“stage of”) change • risk estimation (normative and non-normative) • change motivation, intrinsic – extrinsic motive • Affective state, • Alcohol & drug use • Social support

9. Indirect effects of Ψ on health; Health behaviors • Group-level variablescontrolling exposure, definition, and availability of (un)healthy behavior • social norms and/or socially structured rewards and punishments • gender, age, cultural group effects; “X”, smoking, etc. • models of (un)healthy behavior; processes of modeling influences • relations of individuals/groups with health “system”; providers, govt., schools, etc. • Cultural level variables • Economic / corporate incentives for (un)healthy behaviors • Main effects of socio-economic disparity • Main effects of ethnicity (“objective” status?)

10. Illness related behaviors2nd / 3rd prevention • Key steps: • Recognition of health problems • Definition of “disturbance” or problem • Treatment or help seeking • Recognition of a health threat • surveillance & early detection • basic health information approaches • Perceived vulnerability & susceptibility: Core precursor of virtually all health models • Weinstein: core Ψ variables (controllability) • Khaneman: Relative irrationality of risk perception • interpretation of symptoms or signs; implicit health models • Health belief model • Info about health threat • “Cues to action” • Health cognitions

11. Illness related behaviors2nd / 3rd prevention • Definition of “disturbance” or problem • interpretation of symptoms or signs; implicit health models • Health belief model • Info about health threat • “Cues to action” • Health cognitions • outcome expectancies for health / illness behavior • “adaptation level” and drifting criteria for diagnosis • Causal attribution models

12. Illness related behaviors2nd / 3rd prevention • Treatment or help seeking • Health belief / health barrier models: approach of treatment source • Individual and group differences in efficacy for behavior change • Coping models: instrumental v. affective coping • Socio-cultural variables in treatment response • adherence to treatments